Our Summary

This research paper discusses the best methods for repairing the bulbar urethra, a part of the male urinary tract that can become narrowed or blocked (a condition called “stricture”). The best method for repairing small strictures (2 cm or less) is to cut out the narrowed part and then stitch the two ends back together. However, this method can cause the penis to shorten, so for larger strictures (greater than 2 cm), a different method is used. Instead of cutting out the narrowed part, a skin flap or a tissue graft is used to widen it. The most common type of tissue used for this is taken from the lining of the mouth (buccal mucosa). The success rate for these surgeries is around 90%, regardless of where the graft is placed.

FAQs

  1. What is the gold standard for bulbar urethroplasty?
  2. How are strictures greater than 2 cm treated in urethroplasty?
  3. What is the most prevalent tissue used for bulbar urethral stricture repair for strictures greater than 2 cm?

Doctor’s Tip

One helpful tip a doctor might tell a patient about urethroplasty is to follow post-operative care instructions carefully to ensure proper healing and reduce the risk of complications. This may include avoiding strenuous activities, keeping the surgical site clean and dry, taking prescribed medications as directed, and attending follow-up appointments with your healthcare provider. It is important to communicate any concerns or changes in symptoms to your doctor promptly.

Suitable For

Patients who are typically recommended for urethroplasty are those with urethral strictures that are greater than 2 cm in the bulbar urethra. These strictures are not suitable for excision and primary anastomosis due to the risk of penile shortening. Augmentation urethroplasty is the preferred approach for these patients, where the narrowed segment is widened using a skin flap or tissue graft, with buccal mucosa being the most common choice for bulbar urethral stricture repair. Overall, outcomes for urethroplasty in these patients are favorable, with success rates around 90%.

Timeline

Before urethroplasty:

  1. Patient presents with symptoms of urethral stricture, such as difficulty urinating, weak urine stream, frequent urination, or urinary tract infections.
  2. Urologist diagnoses urethral stricture through physical examination, medical history, and imaging tests like urethroscopy or urethrogram.
  3. Patient and urologist discuss treatment options, including urethroplasty, for strictures longer than 2 cm.
  4. Patient undergoes pre-operative testing and preparation for surgery.

After urethroplasty:

  1. Patient undergoes urethroplasty surgery, where the narrowed segment of the urethra is widened using a tissue graft, such as buccal mucosa.
  2. Recovery time varies but typically involves a hospital stay of 1-2 days and a catheter in place for 1-2 weeks.
  3. Patient may experience discomfort, swelling, and temporary urinary issues post-surgery.
  4. Follow-up appointments with the urologist are scheduled to monitor healing and address any complications.
  5. Over time, the patient’s symptoms improve as the urethra heals and the stricture is successfully repaired.

What to Ask Your Doctor

  1. What is the success rate of urethroplasty for my specific condition?
  2. What are the potential risks and complications associated with urethroplasty?
  3. How long is the recovery period after urethroplasty?
  4. Will I experience any changes in urinary function or sexual function after the procedure?
  5. Are there any alternative treatments for my condition besides urethroplasty?
  6. How many urethroplasty procedures have you performed, and what is your success rate?
  7. How long will the effects of the urethroplasty last?
  8. Will I need follow-up appointments or additional treatments after the procedure?
  9. What can I do to prepare for the urethroplasty procedure and optimize my recovery?
  10. Are there any lifestyle changes I should make after undergoing urethroplasty to prevent future issues?

Reference

Authors: Levy ME, Elliott SP. Journal: Urol Clin North Am. 2017 Feb;44(1):39-47. doi: 10.1016/j.ucl.2016.08.009. PMID: 27908370